Provider Demographics
NPI:1730873530
Name:CEDARHURST OF LA VISTA OPERATOR, LLC
Entity type:Organization
Organization Name:CEDARHURST OF LA VISTA OPERATOR, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CORPORATE COUNSEL
Authorized Official - Prefix:
Authorized Official - First Name:ALEXANDRA
Authorized Official - Middle Name:NOEL
Authorized Official - Last Name:RICCI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-254-8354
Mailing Address - Street 1:300 HUNTER AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63124-2328
Mailing Address - Country:US
Mailing Address - Phone:314-254-8354
Mailing Address - Fax:
Practice Address - Street 1:8140 S 97TH PLZ
Practice Address - Street 2:
Practice Address - City:LA VISTA
Practice Address - State:NE
Practice Address - Zip Code:68128-7104
Practice Address - Country:US
Practice Address - Phone:402-597-0700
Practice Address - Fax:402-488-0406
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-05
Last Update Date:2023-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility